Arthroskopisch assistierte Frakturversorgung am oberen Sprunggelenk

Abstract

Acute ankle fractures are one of the most common fractures in adults with an incidence of 0.1-0.2 % per year. Operative treatment by open reduction and internal fixation (ORIF) is the standard method of treatment for unstable or dislocated fractures. The main goal of the operation is the anatomical realignment of the joint and restoration of ankle stability; nevertheless, anatomical reduction does not automatically lead to favorable clinical results. According to several studies the mid-term and in particular the long-term outcome following operative treatment is often poor with residual symptoms including chronic pain, stiffness, recurrent swelling and ankle instability. There is growing evidence that this poor outcome might be related to occult intra-articular injuries involving cartilage and soft tissues. In recent studies the frequency of fracture-related osteochondral lesions was reported to be approximately 64 %. By physical examination, standard radiography or even computed tomography (CT), these intra-articular pathologies cannot be reliably diagnosed; therefore, many authors emphasize the value of ankle arthroscopy in acute fracture treatment as it has become a safe and effective diagnostic and therapeutic procedure. Arthroscopically assisted open reduction and internal fixation (AORIF) allows control of the reduction as well examination of all intra-articular structures. If necessary, intra-articular pathologies can be addressed by removing ruptured ligaments and loose bodies, performing chondroplasty or microfracturing. So far there is no evidence that supplementary ankle arthroscopy increases the complication rate. On the other hand, the positive effect of AORIF has also not been clearly documented; nevertheless, there are clear indications that arthroscopically assisted fracture treatment is beneficial, especially in complex fractures.

High incidence of (osteo)chondral lesions in ankle fractures

“…The 1‐year follow‐up showed that AORIF lead to good to excellent results in complex ankle fractures [8]. This is in line with previous articles published by Braunstein et al [6], Liu et al [36] and Lee et al [34] However, Fuchs et al [27] showed no significant functional outcome improvement in patients who underwent AORIF. Another point of discussion is what the surgeon should do when detecting a (osteo)chondral lesion pre‐ or intra‐operatively.…”

Arthroskopische Versorgung des oberen Sprunggelenks

“…Im Erwachsenenalter gehören Sprunggelenkfrakturen zu den häufigsten Frakturen [8]. Eine Vielzahl an Studien hat hierbei gezeigt, dass bei bis zu 90% aller Frakturen konsekutive Knorpelverletzungen vorkommen.…”

Frakturen des Sprunggelenkes

“…Einige nichtbeeinflussbare Risikofaktoren für ein schlechtes Ergebnis wurden bereits identifiziert (hoher Body-Mass-Index, fortgeschrittenes Patientenalter, Verletzung mehrerer Malleoli, Syndesmoseninstabilität) [4,5]. Einige Faktoren können aber durch den Operateur positiv beeinflusst werden, wie beispielsweise die Qualität der Reposition, die Identifizierung und Behandlung von intraartikulären Begleitverletzungen, die anatomische und dauerhafte Wiederherstellung des distalen Tibiofibulargelenks sowie die Verminderung von Komplikationen durch die Wahl der geeigneten Operationstechnik [4,6,7]. Lange Zeit wurden bei der Behandlung der Sprunggelenkfrakturen althergebrachte Behandlungsstrategien und Dogmen unkritisch übernommen.…”